Perceptions and determinants of oral health care among Iranian pregnant women: a qualitative study

Main findings

The study aimed to provide a comprehensive understanding of the determinants of oral healthcare among Iranian pregnant women. The study examined oral healthcare behaviour in pregnant women from multiple perspectives, including midwives/healthcare workers, supervisors of prenatal care services and dentists. The results provide a coherent and complete picture of the determinants of oral healthcare behaviour during pregnancy.

This study suggests that oral health literacy and understanding the importance of oral healthcare are crucial factors in preventing tooth decay during pregnancy. The results of a 2020 study on oral health literacy among 169 pregnant women in Kerman, Iran, indicated insufficient literacy levels. The study highlights the necessity of dental consultation before pregnancy to improve oral health literacy among pregnant women.24 Another study on the oral health literacy of 2263 pregnant women suggests that it is necessary to improve the oral health literacy of pregnant women with the help of education.25

This study found that pregnant women often neglect their oral and dental hygiene due to a lack of attention given by oral healthcare providers and insufficient education and sensitivity provided to pregnant women. As a result, pregnant women tend to rely on unprofessional oral care. Most of the participating pregnant women stated that they need to receive the necessary training from prenatal care providers in this field, especially in the first level of prevention. Oral healthcare providers need to prioritise and educate pregnant women about the importance of maintaining good oral and dental hygiene during pregnancy. However, it is possible that pregnant women may not receive professional training due to a lack of understanding of the importance of oral care during pregnancy and may disregard the training provided by oral healthcare providers.26 According to a 2019 study, one of the most significant reasons for not using oral healthcare is the lack of awareness of its importance. This issue was identified as an intergenerational responsibility, meaning that the health status of one generation can influence that of the next.27

The participants suggested that the habit of performing oral care should be institutionalised in the individual from childhood, and the culture of prevention and timely treatment should be strengthened. The results of previous studies emphasised the comprehensive education of pregnant women about the importance of oral health during pregnancy.28 29

From the participants’ point of view, performing examinations before and during pregnancy plays a vital role in maintaining oral health. However, access, attitude and awareness of women before pregnancy should be improved.13

The oral health providers in the study suggested reinforcing positive behaviours and correcting negative behaviours in mothers. Pregnant women can benefit hugely from education that promotes caring behaviours and minimises the limitations of pregnancy. Improving oral health outcomes during pregnancy can be achieved through regular dental care, education, broader oral health coverage, routine oral health maintenance and access to resources. The results of various studies in Iran also indicate the effectiveness of education on the awareness of pregnant women in this area and the promotion of oral care behaviours.30 31

Several factors, including lack of time, high cost and fear of complications for the fetus, can cause reluctance to receive dental services during pregnancy, as highlighted by Mousa et al’s study in 2019; However, encouraging regular dental care, providing education, advocating for broader oral health coverage, reinforcing routine oral health maintenance and informing pregnant women about the importance of oral health can all contribute to improving oral health outcomes during pregnancy.32

Bao et al’s study evaluated and summarised clinical practice guidelines on the prevention, diagnosis and treatment of dental diseases during pregnancy. The study found that published clinical guidelines provide clear messages and guidance to dentists for providing timely and safe care during pregnancy.33

Most participants found dental services too expensive, hindering dental visits. Pregnant women may face significant financial constraints when it comes to receiving oral care. According to a population-based study conducted among Iranian women in 2019, the main reasons for not receiving oral services during pregnancy were lack of perceived need and financial barriers.

In Iran, oral care services are not completely covered by health insurance, which means households have to pay high out-of-pocket expenses to receive oral care.34 Evidence suggests that having insurance coverage can significantly improve access to oral health services, enhance service quality and reduce financial barriers to utilisation.35 However, lack of adequate insurance coverage, incomplete oral services in public sectors, people’s lack of trust in their quality, poor access to services and customer dissatisfaction are among the problems of oral services provided in public health centres in Iran.

Health professionals are concerned about the ever-increasing tariffs and the lack of access for all pregnant women to oral services in Iran. Oral care guidelines in pregnancy should be updated to prioritise oral health. Also, it is essential to have seamless cooperation and coordination between healthcare providers, such as midwives, obstetricians and dentists, to ensure optimal oral healthcare for pregnant women. A study conducted in 2021 suggests that interprofessional collaboration can significantly improve oral healthcare utilisation.36 The effectiveness of the referral system and patient-centred care team in reducing oral diseases among pregnant women has been emphasised in various studies.37 38

Participants in a study emphasised that effective communication and interaction among healthcare team members, particularly dentists, are crucial for performing oral care practices. Therefore, dental professionals must develop and maintain strong interpersonal communication skills to establish trust and enhance patient satisfaction with their care previous studies have also confirmed this finding.39 40 The participants suggested that Telegram and WhatsApp are promising platforms for promoting oral health among pregnant women. A study conducted in 2020 also highlights the potential of smartphones and social networks as an initiative to promote prenatal oral healthcare.41

The participants in the study emphasised the importance of family, government and cultural support to maintain oral health and improve self-care behaviours. In line with our findings, according to a 2019 study, women whose medical providers promoted oral healthcare were nearly wo times as likely to have a dental visit during pregnancy.40 Therefore, health centre education can influence dental visits during pregnancy.

Educating oral health in families, encouraging dental visits, integrating oral health into general health and paying specific attention to prenatal oral health are some recommendations that can implemented to improve oral healthcare for pregnant women in Iran.

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